Arteriovenous fistula or graft creation in end-stage renal disease leads to right ventricular remodeling, dysfunction, incident heart failure, and increased risk of death during long-term follow-up.
Observational
Does the creation of an arteriovenous fistula or graft lead to adverse cardiovascular changes in patients with end stage renal disease?
AVF/AVG creation in ESRD patients is associated with long-term detrimental right heart remodeling, incident heart failure, and increased mortality risk.
AIMS: Short-term studies have reported left ventricular (LV) dilatation following surgical creation of arteriovenous fistulas (AVF) or arteriovenous grafts (AVGs), but chronic cardiac structural and functional changes have not been examined or related to clinical outcomes following AVF/AVG. We sought to characterize the long-term changes in cardiac structure and function in patients undergoing shunt creation for haemodialysis. METHODS AND RESULTS: A retrospective analysis was performed of patients undergoing echocardiography before and after surgical AVF/AVG creation for the initiation of haemodialysis. 137 patients underwent echocardiographic examinations prior to AVF and 2.6 years (median) after AVF creation. Following AVF and dialysis initiation, there were reductions in blood pressure, body weight and estimated plasma volume coupled with modest reverse LV remodelling. In contrast, AVF/AVG creation was associated with significant right ventricular (RV) dilatation and deterioration in RV function. Incident heart failure (HF) developed in 43% of patients in tandem with greater RV remodeling. The development of RV dilation following surgical AVF/AVG was independently associated with increased risk of death HR 3.9, 95% CI (1.7-9.2), P = 0.001. CONCLUSION: In long-term follow-up, RV remodelling and dysfunction develop following AVF/AVG creation and dialysis initiation, despite improved control of LV pressure load through dialysis. Deleterious effects on right heart structure and function are coupled with development of incident HF and increased risk of death. Further study is required to identify patients at greatest risk for detrimental AVF/AVG changes who may benefit from alternate forms of dialysis or potentially ligation of existing AVF.
Reddy et al. (Mon,) conducted a observational in End stage renal disease. Arteriovenous fistula (AVF) or graft (AVG) creation was evaluated on RV remodelling, dysfunction, incident HF, and death. Arteriovenous fistula or graft creation in end-stage renal disease leads to right ventricular remodeling, dysfunction, incident heart failure, and increased risk of death during long-term follow-up.